The Incentives Affecting the Selection of Future Specialty of Medical Interns

Introduction:

Selecting field at the academic level is one of the most important decisions of a person during his lifetime. By choosing a field of study, one needs to spend a lot of time being educated. Therefore, the choice of the field of study at all levels should be done with greater care and consideration (1). Selection of fields related to medical sciences, including the medicine itself, which is related to human health, needs to be done more carefully; because the interest in the field is one of the preconditions for providing high quality services to patients (2).

 The increasing number of general practitioners and the lack of adequate capacity and facilities have made career choices one of the main concerns of medical students during their post-graduate years. The tendency toward admission to specialized medicine is one of the most important concerns of most medical students and graduates in this field (3). On the other hand, the disparity between the needs of the country to medical specialists and the interest of the graduates of general medicine to the specific specialized fields, causes problems.

 The incentives for choosing a specialty is a complex process influenced by various factors. Teaching students during externship courses is one of the most important factors influencing the choice of specialty in developing countries; however, factors such as willingness to be employed at the university, family education, parent’s education, better communication with people, better economic situation, accessing better work and more income, better social status and access to more information can not be ignored, although this pattern of incentives varies in developing and developed countries (4-9).

In the United States, type of patient's problems, suitability with personality, having the skills and abilities for the field, the opportunity to make changes in people's lives, content of the field, the challenge with diagnostic problems and the variety in the diagnosis of treatment, are the factors that have great influence on selecting the specialty, respectively (10).

 In South Korea, female students tended to specialties with less working hours and risk, while male students were more willing to continue their studies in surgery and in specialties with higher income (11). In Scotland, the balance of living and work, and the number of patients were the factors affecting selection of specialty (1).

 In a study conducted at Mazandaran University of Medical Sciences in Iran, the two most influential factors in choosing a specialty were the interest in helping people and the scientific content of the field. Factors such as the cost of medical malpractice and patient contact had the least effect on the choice of specialty. Most men emphasized the lack of affiliation of the specialty, while women emphasized the predictability of work hours (12).

Considering that educating a medical student, as one of the most important people who directly affects people's health and is connected with the health of society having a significant role in the development of health system of the country and given the fact that having interest is essential to be successful in the field and to have healthier communication with patients, leading to general health and promoting health status of the country, this study aimed to investigate the effective incentives on choosing the specialty in medical students of Mashhad University of Medical Sciences.

Methods:

In this cross-sectional study, all medical students who were interns in 2015 were included in the study using census. Inclusion criteria included students who were admitted to Mashhad University of Medical Sciences, and guest students were not included in this study, and the only exclusion criteria was forms with very incomplete information. Accordingly, 6 questionnaires were excluded from the study and 243 subjects were analyzed. All information was collected by a questionnaire that was designed in two sections. In the first part, questions about the demographic status and the six selected subjects of interest were in priority order and the second part included 20 questions regarding the future job motives. Questions in the second part were designed as multiple choice questions including fully agree, agree, abstained, disagree, and completely disagree about future job plans. In this study, the modified form of the Medical School Graduation Questionnaire was used. Validity and reliability of this questionnaire have been studied in foreign studies and have been applied in Iranian studies according to the country’s education system and its validity and reliability have been confirmed (2, 13). Volunteers were asked to identify the influence of the factors raised in the questionnaire on their first selection of their field of specialty. For each factor, the Likert Scoring System was used. Thus, zero indicates lack of influence, one indicates low impact, two indicates moderate influence, and three indicates strong influence, and a score of four indicates a factor that had a significant impact on the choice of specialty. After collecting data, they were first coded into each specialty and then in four groups of surgery, internal medicine, diagnostic medicine, and psychiatry and were entered into the computer. First, using SPSS software version 19 and EXCELL, the data were described (frequency and charts) and Chi-square and Mann-Whitney tests were used to analyze the data. In this study, the level of significance for statistical tests was considered as 0.05.

 Results:

Of 243 medical intern students of Mashhad University of Medical Sciences in 2015, the mean age of 243 participants in this study was 24.76 ± 0.66. Of the total number of participants in this study, 134 (55.1%) were women and 109 (44.9%) were men; 103 (42.4%) of the participants were married and 140 (57.6%) were single (table 1).

In figure 1, the percentage of interns’ preferred fields of specialty are shown in general, indicating that the most favorite specialties are radiology (24.65%), cardiovascular diseases (12.45%) and ophthalmology (11.6%) and the infectious disease (0.35%) was the least interested specialty among students.

 After dividing the specialties into four general categories of psychiatry, diagnostic medicine, internal medicine and surgery, there was a significant difference between the genders and field of specialty based on the chi-square test )p=0.003, (; this difference was divided into four general categories and is shown in figure 2, which indicates that women tended to be more interested in diagnostic medicine and internal medicine, and men were more interested in surgery, and the interest was the same in psychiatry fields

Figure 1. Frequency of interns' preferred fields of specialty

Table 2 shows the interest of students by gender, which indicates that after radiology, men are more interested in cardiovascular diseases, ophthalmology and orthopedics, and women are more interested in pathology, cardiovascular diseases and ophthalmology, and a remarkable point in this study is that none of the men chose infectious diseases and oncology and none of the women chose orthopedics and urology fields.

 

Figure 2. The frequency of students’ favorite fields of specialty by gender

Table 3 shows the factors influencing the choice specialty field by gender. According to the results of the Mann-Whitney test, in some cases such as the interesting field of specialty, having certain working hours, the desire and encouragement of the family, the impact of the specialty on improving interpersonal and family relationships, having enough time for family, the experience of externship and internship periods, city of residence, the possibility of working in the operating room, the suitability with personality, and favorable income in relation to working time, there were significant differences between the mean scores of the two genders, which, accordingly, after good income for both genders, which had the greatest effect on their choice, in men, the interesting and challenging specialty and in women, prestige of the specialty and encouragement of the family are the most influential factors.

Discussion:

The results of our study showed that the most favorite medical specialty among medical intern students were radiology, cardiology, ophthalmology, pathology, dermatology, orthopedics, internal medicine, obstetrics and gynecology, psychiatry, neurosurgery, general surgery, pediatrics, urology, ENT, internal medicine and infectious diseases and oncology. In a study conducted in Switzerland, students were mostly interested in primary care, internal medicine, surgery specialties, obstetrics and gynecology, anesthesiology and special care, pediatrics, and psychiatry (14) In another study, the most favorite fields were internal medicine, surgery, family medicine, pediatrics, psychiatry, obstetrics and gynecology, and hospital-related specialties (15). However, given that these are foreign studies, the differences can be attributed mainly to cultural and regional differences.

 The most interest in continuing education at the specialized level for both genders was radiology. In the study of MEHMOOD et al., surgery was the most popular specialty among students (16); which can be due to the proper position of radiology (in terms of income and difficulty of studying) in our country.

 Other results of our study were the incentives that influenced the selection of specialty fields. In this study, the most influential incentives were the following: adequacy of income over working time, the desire and encouragement of the family, having enough time for family, professional security and health and prestige of specialty in the perspective of other colleagues and society, while in a study in Pakistan, factors such as lifestyle, clinical practice, social factors and occupational prestige were influential (17). In the study of Zarghami et al., the two most influential factors in choosing the fields of specialty were interest in helping people and the scientific content of the specialty field (12). In the U.S., the most influential factors were the type of problem, the suitability with the personality, skills and abilities for the relevant field, the opportunity to make a difference in people’s lives (13). In Denmark, issues relating to a controllable lifestyle such as the availability of leisure time or spending enough time with the family, the amount of stress, workload, and employment commitments had the greatest impact on choosing the specialty field (18).

Regarding the influential incentives by gender in this study, such as interesting specialty, having certain working hours, desire and encouragement of family, the impact of specialty on improving interpersonal and family relationships, having enough time for family, experiences of externship and internship periods, city of residence, possibility of working in the operating room, suitability with the personality and acceptable income in relation to working time, there were significant differences between the two genders. In men, interesting specialty and in women, the prestige of the specialty and encouragement of the family had the greatest impact. In the study of Zarghami et al., men mostly emphasized on the lack of dependency of the specialty and women emphasized mostly on the predictable working hours (12). In Denmark, women were more concerned with the relationship with the patient and men were more concerned with self-discipline (19).

 Based on the present study, currently, it seems that students are more concerned with issues such as income and the ease of study than they are concerned with their interests and academic qualities and competencies. One of the limitations of this study is its cross-sectional nature, and the study was conducted in one year; while having information of consecutive years, the motivational changes can be reviewed and planned upon. One of the other limitations of this study is the fact that it only addresses effective motives, while this is a multifactorial issue, and other factors, such as the personality trait of individuals and the education of the family, ... can influence the selection of the field; therefore, it is suggested that future studies should consider other aspects of this issue.

Given the increasing number of physicians in the country, especially in recent years, the medical profession will undergo a transformation. The factors discussed are those that can influence the decision making of general practitioners in choosing specialized fields. Although during the specialty period, different events and experiences can bring about changes in students' opinions. Nevertheless, knowing the incentives that affect the choice of specialty can help in planning educational programs. Further research can help clarify this issue.

 Acknowledgements:

The authors would like to thank the Vice-Chancellor for Research in Mashhad University of Medical Sciences. This paper is extracted from the thesis No. 921173 at the Faculty of Medicine, Mashhad University of Medical Sciences.

 Financial Support: This paper is extracted from the thesis No. 921173 at the Faculty of Medicine, Mashhad University of Medical Sciences.

 Conflict of Interest: The authors have no conflicts of interest in relation to this paper.